Recent developments in non-invasive blood glucose monitoring technology

Diabetes mellitus is a huge and significantly grow ing problem. Continuous and real-time monitoring of blood glucose plays a key role for the people with diabetes,which can help them to control glucose concentration more effectively. However,current blood glucose monitoring methods require blood by needle-pricking,which limit the detection frequency. It is necessary to develop non-invasive blood glucose monitoring methods to achieve the ideal therapeutic and management of diabetes. In this paper,the developments and challenges of non-invasive blood glucose monitoring technologies in recent years are reviewed. And the bottleneck and the developing trends are also analyzed.

A Study on Near-Infrared Non-Invasive Blood Glucose Concentration Regression Prediction Based on PSO-MKL-SVR

To improve the accuracy of predicting non-invasive blood glucose concentration in the near-infrared spectrum, we utilized the Particle Swarm Optimization (PSO) algorithm to optimize hyperparameters for the Multi-Kernel Learning Support Vector Machine (MKL-SVR). With these optimized hyperparameters, we established a non-invasive blood glucose regression model, referred to as the PSO-MKL-SVR model. Subsequently, we conducted a comparative analysis between the PSO-MKL-SVR model and the PSO-SVR model. In a dataset comprising ten volunteers, the PSO-MKL-SVR model exhibited significant precision improvements, including a 16.03% reduction in Mean Square Error and a 0.29% increase in the Squared Correlation Coefficient. Moreover, there was a 0.14% higher probability of the Clark’s Error Grid Analysis falling within Zone A. Additionally, the PSO-MKL-SVR model demonstrated a faster operational speed compared to the PSO-SVR model.

Accuracy of pipeline blood glucose monitoring in patients with severe liver injury undergoing artificial liver support system treatment

Severe deterioration of liver function in patients can be characterized by coagulation disorders, jaundice, hepatic encephalopathy, ascites, and other symptoms. Severe liver injury can develop as acute liver failure, subacute liver failure, acute-on-chronic liver failure, or further worsening of end-stage liver disease [1].

Parsimonious Model for Blood Glucose Level Monitoring in Type 2 Diabetes patients

To establish the parsimonious model for blood glucose monitoring in patients with type 2 diabetes receiving oral hypoglycemic agent treatment. One hundred and fifty-nine adult Chinese type 2 diabetes patients were randomized to receive rapid-acting or sustained-release gliclazide therapy for 12 weeks.

Investigation and Analysis on the Management Standard of Blood Glucose Monitoring for Clinical Nurses in Nyingchi Region of Tibet

Background: In participating in the medical support work in the Nyingchi area of Tibet, the author found that the medical education resources in this area are scarce, and the clinical nurses in this area have relatively insufficient knowledge about blood glucose monitoring and management. Accurately understanding the knowledge-attitude/belief-practice (KAP) level of nurses in Nyingchi area on blood glucose management is of great significance to the development of blood glucose monitoring management guidance for nurses in this area. Therefore, this study investigated the current status of the management of blood glucose monitoring management standards for clinical nurses in Nyingchi, Tibet. Objective: To investigate and analyze the current situation of clinical nurses in Nyingchi region of Tibet to grasp the regulation of blood glucose monitoring and guide the implementation of the norm of blood glucose monitoring for clinical nurses. Methods: The research survey was carried out from March to April 2020. Random sampling method was used to select 134 clinical in-service nurses in Nyingchii, Tibet. The self-designed knowledge-attitude/belief-practice survey questionnaire for clinical nurses’ blood glucose monitoring and management in Tibet was used. Nurses’ blood glucose monitoring management “KAP” scores and related influencing factors are analyzed. Results: Blood sugar monitoring and management knowledge score is (36.78 ± 6.80), attitude dimension is (42.48 ± 6.42), practice dimension is (61.87 ± 10.24) and total score is (304.73 ± 36.24). The nurse’s department and whether to participate in diabetes training are the main influencing factors of the blood glucose monitoring management norms, knowledge and behavior (both P < 0.05). Conclusion: The standard knowledge of blood glucose monitoring and management of clinical nurses in Nyingchi region of Tibet is at the middle level, positive attitude and unsatisfactory behavior. Nursing managers should conduct standardized training for clinical nurses in blood glucose monitoring, develop the training mode of diabetes specialty nursing talents in Nyingchi area, and construct a complete management system of diabetes specialty nursing.

Development of Wearable Semi-invasive Blood Sampling Devices for Continuous Glucose Monitoring: A Survey

Semi-invasive blood sampling devices mimic the way female mosquitoes extract blood from a host. They generally consist of a microneedle, a microactuator for needle insertion, a blood extraction mechanism and a blood glucose sensor. These devices have great potential to overcome the major disadvantages of several current blood glucose monitoring methods. Over last two decades, extensive research has been made in all of these related fields. More recently, several wearable devices for semi-invasive blood sampling have been developed. This review aims at summarizing the current state-of-the-art development and utilization of such wearable devices for continuous monitoring of blood glucose levels, with a special attention on design considerations, fabrication technologies and testing methods.

Self-monitoring of blood glucose in gestational diabetes mellitus patients during the COVID-19 pandemic in low- and middle-income countries

Self-monitoring of blood glucose(SMBG)is critical for gestational diabetes mellitus(GDM)care.However,there are several hurdles to its practice during the coronavirus disease 2019(COVID-19)pandemic in GDM patients in low-and middle-income countries when GDM care recommendations emphasize telemedicine-based care.Based on available knowledge,this letter proposes the following barriers to SMBG in these GDM patients during the ongoing COVID-19 pandemic:Poor internet connectivity,affordability of SMBG and digital applications to connect with healthcare providers,government-imposed social mobility restriction,psychological stress,and mental health conditions.Nevertheless,definitive evidence will only be acquired from rigorous research.

Effects of Continuous Non-Invasive Blood Pressure Monitoring on Intraoperative Hemodynamics and Postoperative Myocardial Injury in Craniotomy:Comparison Between Groups Based on Self-Control and Propensity Score Matching

Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divided into the self-control group(continuous non-invasive blood pressure monitoring and intermittent cuff non-invasive blood pressure monitoring,CNAP group)and propensity score matching group(only intermittent cuff non-invasive blood pressure measurement in previous craniotomy,PSM group);Goal-directed hemodynamic management in CNAP group included heart rate(HR),blood pressure(BP),stroke volume(SV),stroke variability(SVV),and systemic vascular resistance index(SVRI).The main index is to compare the troponin level within 72 hours after operation between the CNAP group and the PSM group;The secondary indicators are the comparison of the hemodynamic conditions between the CNAP group and the PSM at 10 specific time points.Results:The incidence of postoperative myocardial injury in the CNAP group was significantly lower than that in the PSM group(12%vs.30%,P=0.01);in the CNAP group hypotensive episodes(6 vs.3,P=0.01),positive balance of fluid therapy(700 vs.500 mL,P<0.001),more use of vasoactive drugs(29 vs.18,P=0.04),more stable hemodynamics medical status(P=0.03)were recorded.Conclusion:The hemodynamic management strategy based on continuous non-invasive blood pressure monitoring can reduce the incidence of myocardial injury after elective craniotomy and maintain a more stable hemodynamic state.

Non-invasive glucose measuring apparatus based on conservation of energy method

A new non-invasive blood glucose measuring apparatus (NBGMA) made up of MSP430F149 SCM (single chip micyoco) was developed,which can measure blood glucose level (BGL) frequently,conveniently and painlessly. The hardware and software of this apparatus were designed,and detecting algorithms based on conservation of energy method (COEM) were presented. According to the law of conservation of energy that the energy derived by human body equals energy consumed by metabolism,and the relationship between convection,evaporation,radiation and the BGL was established. The sensor module was designed. 20 healthy volunteers were involved in the clinical experiment. The BGL measured by an automatic biochemical analyzer (ABA) was set as the reference. Regression analysis was performed to compare the conservation of energy method with the biochemical method,using the 20 data points with blood glucose concentrations ranging from 680 to 1 100 mg/L. Reproducibility was measured for healthy fasting volunteers. The results show that the means of BGL detected by NBGMA and ANA are very close to each other,and the difference of standard deviation (SD) is 24.7 mg/L. The correlative coefficient is 0.807. The coefficient of variation (CV) is 4% at 921.6 mg/L. The resultant regression is evaluated by the Clarke error grid analysis (EGA) and all data points are included in the clinically acceptable regions (region A:100%,region B:0%). Accordingly,it is feasible to measure BGL with COEM.

Review of minimally invasive continuous glucose monitoring technology & instruments

Continuous blood glucose monitoring is important for the diagnosis,treatment,and study of diabetes. many organizations have been working on this subject in recent two decades. Glucose concentration in interstitial fluid is closely related to the blood glucose levels. Minimally invasive continuous blood glucose monitoring technology based on the glucose detection in interstitial fluid develops rapidly and gets more and more attentions from the patients and the doctors,due to its instantaneous real-time display of glucose level,"24/7"coverage,and the ability to characterize glycemic variability. According to the different detection methods,most of the continuous glucose monitoring technology could be divided into two kinds: subcutaneous implantation method and transdermal extraction method. This paper review s the recent development of minimally invasive blood glucose monitoring technology and instruments. The mainly remained challenges and related research directions are presented as well.

What,why and how to monitor blood glucose in critically ill patients

Critically ill patients are prone to high glycemic variations irrespective of their diabetes status.This mandates frequent blood glucose(BG)monitoring and regulation of insulin therapy.Even though the most commonly employed capillary BG monitoring is convenient and rapid,it is inaccurate and prone to high bias,overestimating BG levels in critically ill patients.The targets for BG levels have also varied in the past few years ranging from tight glucose control to a more liberal approach.Each of these has its own fallacies,while tight control increases risk of hypoglycemia,liberal BG targets make the patients prone to hyperglycemia.Moreover,the recent evidence suggests that BG indices,such as glycemic variability and time in target range,may also affect patient outcomes.In this review,we highlight the nuances associated with BG monitoring,including the various indices required to be monitored,BG targets and recent advances in BG monitoring in critically ill patients.

Dextrose in the banked blood products does not seem to affect the blood glucose levels in patients undergoing liver transplantation

AIM: Hyperglycemia commonly seen in liver transplantation (LT) has often been attributed to the dextrose in the storage solution of blood transfusion products. The purpose of the study is to compare the changes of the blood glucose levels in transfused and non-transfused patients during LT. METHODS: A retrospective study on 60 biliary pediatric patients and 16 adult patients undergoing LT was carried out. Transfused pediatric patients were included in Group Ⅰ (GⅠ), those not transfused in Group Ⅱ (GⅡ). Twelve adult patients were not given transfusion and assigned to Group Ⅲ(GⅢ); whereas, four adult patients who received massive transfusion were assigned to Group Ⅳ (GⅣ). The blood glucose levels, volume of blood transfused, and the volume of crystalloid infused were recorded, compared and analyzed. RESULTS: Results showed that the changes in blood glucose levels during LT for both non-transfused and minimally transfused pediatric groups and non-transfused and massively-transfused adult groups were almost the same. CONCLUSION: We conclude that blood transfusion does not cause significant changes in the blood glucose levels in this study.

Practice of Glycemic Self-Monitoring in Diabetic Patients Followed at the Endocrinology Department of Donka University Hospital in Guinea

Diabetes is a chronic pathology whose evolution is marked by micro and macroangiopathic complications. Optimal management can prevent the onset of complications and improve patients’ quality of life. Objectives: To determine the frequency of self-monitoring of blood glucose and to describe the errors found during self-monitoring in diabetic patients followed at the Endocrinology Department of Donka University Hospital in Guinea. Materials and methods: Descriptive cross-sectional study carried out between August and September 2020 involving diabetic patients followed up at the Endocrinology and Diabetology Department of the Donka National Hospital, CHU Conakry. Results: A total of 301 patients were enrolled, with an average age of 44.24 ± 21.01 years. 64.12% were female. Type 2 diabetes predominated in 64% of cases. The mean duration of diabetes was 6.14 ± 4.67 years, and 75.08% of patients lived in urban areas. Patients were on insulin in 36.21% of cases, insulin and biguanides (26.25%), hypoglycemic sulfonamide and biguanides (19.27%) and biguanides in 18.27% of cases. The frequency of self-monitoring of blood glucose was 43%, and 38% of patients made errors, notably reusing lancets (60%), not checking the expiration date (55.65%) and not washing their hands (48%). Conclusion: This study shows that self-monitoring of blood glucose is not performed by the majority of patients. Numerous errors were identified during blood glucose testing. Continued therapeutic education on the use of blood glucose meters will help empower patients and improve their quality of life.

Forearm Loss Caused by Automated Non-Invasive Blood Pressure Cuff Malfunction: A Hearsay Report

Failure of an automated blood pressure cuff to deflate when a patient is under general anesthesia can lead to catastrophic consequences if unnoticed for more than three hours [1]. We present this as a hearsay case in which an automated blood pressure cuff of the Spacelabs Ultraview Clinical Workstation monitor (model No. 90385) applied pressure for about five hours resulting in limb thrombosis. In order to analyze this catastrophe, simulation scenarios were tested to elucidate the possible errors and malfunctions that may have led to this injury. We present the analysis of the advantages and validity of the hearsay case report. We also include our proposed criteria that should be required when a hearsay case is considered for publication.

Glucose and Electrolytes Concentrations in Blood and Saliva Samples amongst Diabetics

Diabetes mellitus is a group of metabolic disorders of carbohydrate metabolism in which glucose is underutilized, producing hyperglycaemia. The management requires proper maintenance of glucose and electrolytes within its optimum concentrations. The study was designed to evaluate the possibility of using saliva as an alternative non-invasive sample for the determination of electrolytes. A total of 100 samples were utilized consisting of equal number of control (non-diabetics) and diabetic groups. Fasting blood and saliva were collected employing standard methods. The biochemical parameters were analysed using WHO approved methods and procedures. Independent samples t-test and Pearson correlation were the statistical tools used for the data analysis obtained from SPSS package (version 20). The study revealed a significant increase (p < 0.05) in concentrations of blood and salivary glucose, potassium and calcium when controls were compared to diabetics. Moreover, there was a high level of semblances and patterns between plasma and salivary electrolytes, except for potassium. Therefore, electrolytes and glucose results gotten from the use of saliva could be used to equate to that of blood. Hence, instances of non-accessibility of blood, saliva could be of help.

Detection and management of perioperative blood glucose abnormalities

Diabetes mellitus is a common chronic disease.With the improvement of living standards,the prevalence of diabetes mellitus in China is increasing.There are now more people with diabetes in China(>100 million)than in any other country.About half of these people with diabetes need to undergo at least one procedure in their lifetime.Diabetic patients have a much higher probability of perioperative dysglycemia than the normal population,which has a great impact on their prognosis.In addition,non-diabetic patients may also have abnormal blood glucose levels due to various reasons during the perioperative period,which will also lead to a series of adverse consequences.This ar ticle reviews the perioperative blood glucose management of patients to provide a reference for improving their health status.

Differences in the system accuracy acceptability of four types of blood glucose monitoring systems against five different standards

Objective:This study aimed to evaluate the system accuracy of four types of blood glucose monitoring systems(BGMSs)and explore the differences in the system accuracy acceptability of each BGMS against five different standards.Methods:The glucose measurement values obtained from four types of BGMSs(Roche Accu-Chek® Performa,Bayer Contour™ TS,Sinomedisite Glupad® H1 Plus,and Sinocare® Gold-Accu)were evaluated against the reference values obtained from the biochemical analyzer of the central laboratory.The system accuracy acceptability of each BGMS was determined using the criteria specified in five standards,namely the International Organization for Standardization(ISO)15197:2003,Clinical Laboratory Standards Institute(CLSI)POCT12-A3,ISO 15197:2013,Chinese Society of Laboratory Medicine(CSLM)consensus,and US Food and Drug Administration(FDA)guidelines.Results:From 2018 to 2022,10,980 pairs of measurement values were obtained from 366 glucose meters of four types of BGMSs.Significant correlations were observed between the glucose measurement values from the BGMSs and the reference values from the biochemical analyzer of the central laboratory.The correlation coefficient r was 0.995 for Roche Accu-Chek® Performa,0.994 for Bayer Contour™ TS,0.983 for Sinomedisite Glupad® H1 Plus,and 0.997 for SinocareR Gold-Accu.The acceptability criteria specified in ISO 15197:2003 were met by 100.00%(135/135)of the glucose meters of Roche Accu-Chek® Performa,100.00%(109/109)of Bayer Contour™ TS,81.61%(71/87)of Sinomedisite Glupad® H1 Plus,and 100.00%(35/35)of SinocareR Gold-Accu.Whereas,the acceptability criteria specified in ISO 15197:2013 were met by 99.26%(134/135)of the glucose meters of Roche Accu-Chek® Performa,88.07%(96/109)of Bayer Contour™ TS,58.62%(51/87)of Sinomedisite Glupad R H1 Plus,and 91.43%(32/35)of SinocareR Gold-Accu.Conclusions:Among the four types of BGMSs evaluated,the glucose meters of Roche Accu-Chek® Performa exhibited superior system accuracy.The system accuracy acceptability of each BGMS varied significantly against the acceptability criteria specified in the five different standards.

Self-monitoring of blood glucose in type 2 diabetic patients in China：current status and influential factors

Background Self-monitoring of blood glucose （SMBG） by individuals with type 2 diabetes （T2D） is crucial for long-term health,yet numerous cultural,economic and health factors can reduce SMBG.Most studies on SMBG adherence have come out of the US and Europe,and their relevance to Asia is unclear.The aims of the present study were to assess the current state of SMBG in China and analyze demographic and diabetes-related characteristics that may influence it.Methods In this multi-center,cross-sectional study,5 953 individuals with T2D from 50 medical centers in 29 provinces across China filled out a standardized questionnaire that requested information on demographic characteristics,education level,occupation,income,lifestyle risk factors,duration of diabetes,chronic complications,and frequency of SMBG.Respondents were also asked whether their glycosylated hemoglobin （HbA1c） had been checked in the past 6 months.The most recent values for fasting plasma glucose,2-hour postprandial blood glucose and HbA1c were recovered from medical records.Results Only 1 130 respondents （18.98％） performed SMBG with the recommended frequency,while 4 823 （81.02％） did not.In fact,nearly 2 105 （35.36％） reported never performing SMBG.In the subset of 3 661 individuals on insulin therapy,only 266 （7.27％） performed SMBG at least once a day,while 1 210 （33.05％） never performed it.In contrast,895 of 2 292 individuals （39.05％） on diet/exercise therapy or oral hypoglycemic therapy never performed it.Multivariate Logistic regression identified several factors associated with SMBG adherence：female gender,higher education level,higher income,longer T2D duration and education about SMBG.Conclusions SMBG adherence in our Chinese population with T2D was less frequent than that in developed countries.Several factors influence SMBG adherence：gender,education level,income,T2D duration,therapy regimen and exposure to education about SMBG.

3ehavioral Analysis of Chinese Adult Patients with Type 1 Diabetes on Self-monitoring of Blood Glucose

Background： The information-motivation-behavioral skills （IMB） model of health behavior is an effective tool to evaluate the behavior of diabetes self-management. The purpose of this study was to explore behavioral factors affecting the practice of self-monitoring of blood glucose （SMBG） within the frame of IMB model of health behavioral among adult patients with type 1 diabetes in a single diabetes clinic in China. Methods： A questionnaire with three subscales on SMBG information, motivation, and behavioral skills based on IMB model was developed. Validity and reliability of the measures were examined and guaranteed. Adult patients with type 1 diabetes visiting our diabetes clinic from January to March 2012 （n = 55） were consecutively interviewed. The self-completion questionnaires were administered and finished at face-to-face interviews among these patients. Both descriptive and correlational analyses were made. Results： Fifty-five patients finished the questionnaires, with the median duration of diabetes 4.5 years and the median of SMBG frequency 2.00. Specific SMBG information deficits, motivation obstacles, and behavioral skill limitations were identified in a substantial proportion of participants. Scores of SMBG motivation （r - 0.299, P = 0.026） and behavioral skills （r = 0.425, P = 0.001） were significantly correlated with SMBG frequency. The multiple correlation of SMBG information, SMBG motivation, and SMBG behavioral skills with SMBG frequency was R - 0.411 （R2 = 0.169, P = 0.023）. Conclusions： Adult patients with type 1 diabetes in our clinic had substantial SMBG information deficits, motivation obstacles, and skill limitations. This information provided potential-focused education targets for diabetes health-care providers.

Effect of temperature on noninvasive blood glucose monitoring in vivo using optical coherence tomography-corrigendum

The authors would like to apologize for some mistakes in the letter on Chinese Optics Letters vol. 12, no. 11, page 111701 and wish to make the corrections described below：